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    <loc>https://www.mysticvalleysexualwellness.com/blog/sex-shouldnt-hurt</loc>
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    <lastmod>2026-09-10</lastmod>
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      <image:title>Blog - A special edition… - Make it stand out</image:title>
      <image:caption>Written by Dr. Antonio Gargiulo (advanced endometriosis surgery) and Magen Price, FNP-BC, MSCP (menopause and sexual medicine, Mystic Valley Sexual Wellness), drawing on research published between 2014 and 2026. This article does not replace a consultation with your gynecologist or healthcare provider.</image:caption>
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      <image:title>Blog - A special edition… - Make it stand out</image:title>
      <image:caption>Figure 1. Pelvic floor physical therapy and removing deep disease, when it's the driver, have the strongest evidence for painful sex in endometriosis. Hormonal therapy and psychosexual therapy are solidly supported. Vaginal estrogen or DHEA, lubricants, and moisturizers help comfort, especially with a menopausal component, on lower-certainty evidence. Testosterone, CBD, and vaginal laser aren't shown to treat the pain itself.</image:caption>
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    <loc>https://www.mysticvalleysexualwellness.com/blog/my-favorite-meds-to-de-prescribe</loc>
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    <lastmod>2026-08-26</lastmod>
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      <image:title>Blog - My Favorite Meds to De-prescribe</image:title>
      <image:caption>One of the absolute JOYS of my job is weaning patients off chronic medications they were originally put on to manage symptoms of hormone decline. A sleep aid added in 2019. A low dose antidepressant added in 2021 "just to take the edge off." Maybe a blood pressure medication that started around the same time everything else did. I want to be clear: I never tell a patient to stop a medication on her own, and I'm not suggesting hormone therapy is a replacement for medications you need. But once hormones are optimized, many women find they no longer need medications that were, in hindsight, treating a hormone-related problem with the wrong tool. Here are the ones I see most often.</image:caption>
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    <loc>https://www.mysticvalleysexualwellness.com/blog/global-differences-in-menopause-onset</loc>
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    <lastmod>2026-08-12</lastmod>
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      <image:title>Blog - Global Differences in Menopause Onset - Make it stand out</image:title>
      <image:caption>World Population Review (2026 data so far)</image:caption>
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    <lastmod>2026-07-29</lastmod>
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      <image:title>Blog - Estrogen and ADHD - Make it stand out</image:title>
      <image:caption>Whatever it is, the way you tell your story online can make all the difference.</image:caption>
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    <loc>https://www.mysticvalleysexualwellness.com/blog/testosteroneacne</loc>
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    <lastmod>2026-07-15</lastmod>
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      <image:title>Blog - Testosterone brought my spark back… and my acne - I saw it coming</image:title>
      <image:caption>It did not take long for me to notice a difference with testosterone therapy. First came increased energy through the afternoon into late evening, then came motivation to exercise, improved endurance through my workouts, and finally – a lifting of my brain fog. My memory was sharper, my work was more efficient, and I finally felt like me again. Success! Unfortunately, along with all these incredible changes, came an old nemesis: acne. I had horrible acne growing up. Truly horrible – the kind you get bullied for. I was prescribed Accutane twice (RIP to my gut microbiome, but wow did it work), and eventually found a long-term regimen that worked for me. Now, I’ve prescribed testosterone to women long enough to know what I was in for. Given my history, I knew my acne would likely return, but to what extent I wasn’t sure. What I was sure of? I was feeling so depleted and exhausted, and my testosterone level was so low, that a recurrence of my acne was worth it.</image:caption>
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    <lastmod>2026-07-01</lastmod>
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      <image:title>Blog - PMDD and Progesterone - Make it stand out</image:title>
      <image:caption>Allopregnanolone and PMDD: the inverted-U curve theory</image:caption>
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    <loc>https://www.mysticvalleysexualwellness.com/blog/anxietyinmidlife</loc>
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    <lastmod>2026-07-01</lastmod>
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      <image:title>Blog - Anxiety in Midlife - Make it stand out</image:title>
      <image:caption>Representation of what hormones do over the course of a woman’s life</image:caption>
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